Friday, July 31, 2015

A new study from Consumer Reports has analyzed hospital-acquired infection data for thousands of hospitals across the U.S. and rated them on how well they prevented these infections.

Not all hospitals in Kentucky were rated, but of the ones that were, with scores rated from 1 to 100, Consumer Reports gave the highest safety scores to Clark Regional Medical Center in Winchester (68), Baptist Health La Grange (67), Crittenden County Hospital in Marion (66), and Williamson ARH Hospital in South Williamson (64).

Harlan ARH Hospital (25), Clinton County Hospital in Albany (27), Pikeville Medical Center (36) and University of Louisville Hospital (37) were on the low end of the safety scores.

The safety score is a summary five different categories that relate to hospital safety: avoiding infections, avoiding readmissions, communicating about medications and discharge, appropriate use of chest and abdominal scanning and avoiding mortality.

Consumer Reports says it focused on these two infections because they are "common and deadly" and also because" they are red flags that a hospital isn't following best practices to prevent infections." Only 6 percent of hospitals scored well against both infections, none of them in Kentucky, says the report.

The other infections included in this category are central-line associated bloodstream infections, catheter -associated urinary tract infections and surgical site infections. You can find these specific rankings by clicking on the "Compare Hospitals" option. Rankings were based on data reported to the federal Centers for Disease Control and Prevention between October 2013 and September 2014.

“Hospitals can be hot spots for infections and can sometimes amplify spread,” Dr. Tom Frieden, director of the CDC, told Consumer Reports. “Patients with serious infections are near sick and vulnerable patients—all cared for by the same health care workers sometimes using shared equipment.”

Every year an estimated 648,000 people in the U.S. develop infections during a hospital stay, and about 75,000 die with them, the CDC says. "That’s more than twice the number of people who die each year in car crashes," says the report.

Consumer Reports says hospitals that scored well were best at two things: They have systems in place to make sure antibiotics are being used wisely and systems in place to keep the hospital "scrupulously clean," including systems to assure basic hygiene practice are being done, like washing hands.

Consumer Reports reminds patients that they can insist on cleanliness while in the hospital, offering these tips: Ask to have your room cleaned if it looks dirty, keep bleach wipes at your bedside and wipe down your immediate area, ask your care-givers and guest to wash their hands, make sure tubes are changed on schedule and removed as soon as possible, ask for assistance in washing your own hands. It also notes that it is important to question the use of antibiotics, making sure they are needed and appropriate for your infection, to say no to razors as they can nick the skin and provide an opening to infection, to ask about MRSA screening and to pay attention to heartburn medications, which can increase the risk of developing C. diff.

In an effort to help further reduce hospital-acquired infections, Kentucky enacted legislation in January that redefines HAIs and HAI infections and requires simultaneous data reporting to the CDC and the state Department for Public Health. It will also require electronic reporting via the Kentucky Health Information Exchange beginning 2016. The law was prompted because the CDC has no authority to act on the data. Before the law, the health department had the authority, but not the data.

UPDATE, Aug. 11: The school board made up part of the health department's budget cut, allowing it to keep seven nurses, "but not before a lengthy discussion which included talk of salary cuts and new pay scales for nurses," The Interior Journal reports.

The Lincoln County School District joins the ranks of Kentucky schools that are at a loss regarding how to pay for its school nurses as school budgets and health department budgets dwindle, so much so in Lincoln that it may lose four registered nurses for the upcoming school year, Abigail Whitehouse reports for The Interior Journal.

Many school districts have relied on local health departments to help pay for its school nurses, but cuts in federal and state funding, as well as a reduction in Medicaidreimbursements have forced health departments to ask for more money from schools to fulfill this role.

That is the case for the Lincoln County Health Department, which had to cut $150,000 in local funding toward the school nurse program, Health Department Director Diane Miller told Whitehouse.

“We're not able to fund them at the level (we were) but we are still going to go ahead and provide services to the Medicaid population and we will continue to bill those services for them,” Miller said.

The Lincoln County Board of Education held a special meeting July 14 to discuss the lack of funding for its school nurse program and the potential reduction of RNs at each school, Whitehouse reports.

Director of Student Support Services Eva Stone painted a picture with numbers that conveyed how vitally important school nurses are. "Of the nearly 4,000 students in the district, there were 1,755 health conditions reported during the 2014-15 school year and 905 alerts were reported, which she said typically means there might need to be some medical intervention done at school," Whitehouse writes.

Stone spoke to the value of nurses as a means of keeping kids at school. "Of the 13,280 total visits to the school nurse last year (through the middle of May) 93 percent of those students were sent back to class," Whitehouse writes. Stanford Elementary SchoolPrincipal Brandi Hon concurred and told the board that because school nurses keep kids in school, this helps maintain funding because of fewer student absences.

Stone is searching for a solution and told the board that she will have a meeting with Danville-based Ephraim McDowell Health, Whitehouse reports. The school board gave her until its next meeting on Aug. 6 to find a new partnership or alternate funding.

But the bottom line is that if the district can't come up with $150,000, four nurses will be cut, leaving five nurses to cover ten schools, Whitehouse reports.

Superintendent Karen Hatter told Whitehouse that district funding for the school nurse program has been about $250,000 a year and paid for from a contingency fund, or money left over after the district expenses are budgeted. But a school-bus wreck and a central-office fire in 2014 have caused insurance rates and deductibles to increase, which will draw down the fund.

"Hatter said she values the program and understands the concerns but she is also in charge of keeping the school district budget solvent," Whitehouse reports.

Thursday, July 30, 2015

A year of perseverance, education and community input by the local and district health departments paid off as the Clinton County Board of Education voted July 20 to make its schools 100 percent tobacco free, reports the Clinton County News.

Clinton County joins Somerset, Casey County, Adair County and Russell County as school districts in the Lake Cumberland District Health Department area with tobacco-free policies. The area was home to thousands of tobacco farmers, but there are only hundreds now, 11 years after the end of federal quotas and price supports.

It all began last year when the Clinton County board told Ashley Bridgman, health educator for the Wayne, Clinton and Cumberland County health departments, that they needed more education before they could vote on a tobacco-free school policy in their district, the newspaper reports.

Bridgman said this prompted her to look at other districts as a model for Clinton County and distribute surveys to help determine public opinion on the issue. The survey was part of a larger public opinion poll conducted by the district health department.

The poll found that 86.55 percent of the survey respondents in Clinton County were in favor of completely tobacco-free schools. It also asked, "Would you like to see our school become tobacco-free at all events?" Though this included athletic events, the results were basically the same: 85.3 percent said yes. The poll of 749 residents had an error margin of plus or minus 3.6 percentage points.

The poll also found that 77 percent of teachers said they would "definitely" support making the schools 100 percent tobacco-free.

“A lot of community members want this change in our schools,” Bridgman told the newspaper.

The health department presented the survey and other findings to the school board June 15. The board took no action, but five weeks later, on July 20, members unanimously made all schools 100 percent tobacco free starting at the beginning of the 2016-17 school year. The delay is meant to give the public more time to adjust to the new rule.

The county received a $14,000 tobacco-free campus grant to be used for a 12-month media campaign and public awareness program to inform the public about the Tobacco Free School program, which will be led by Bridgman. A similar campaign was set up in Casey County, which will go tobacco-free this school year.

Now that the policy has been approved, Bridgman told the paper, “There has been a lot of tears, but I’m very excited. It’s for the community, it’s for the kids, and it’s for the health, and that’s very important.”

As of June, 44 school districts, out of 173 in Kentucky, were entirely tobacco-free, according to the state's "100% Tobacco Free Schools" website.

Wednesday, July 29, 2015

Americans are eating fewer calories for the first time since the government began keeping track, more than 40 years ago. While that's a step in the right direction, one researcher says that it is not enough to reverse the obesity epidemic, Margot Sanger-Katz reports for The New York Times.

The greatest decrease in calorie intake was found among children of all major demographic groups (with some variations), by at least 9 percent, Sanger-Katz reports.

image from fitfamilytogether.com

Much of this calorie decrease has come from people drinking less full-calorie soda, of which consumption has decreased in the U.S. by 25 percent since the 1990s, Sanger-Katz reports. Credit is also given to an influx of scientific research that emerged in the 1990s about the costs of obesity, and to more recent public health campaigns.

“I think people are hearing the message, and diet is slowly improving,” Dr. Dariush Mozaffarian, the dean of the Friedman School of Nutrition Science and Policy at Tufts University, told the Times.

Americans' eating habits began to rapidly change in the mid-1970s, with calorie consumption increasing steadily to its highest peak in 2003, Sanger-Katz writes.

“This was like a freight train going downhill without brakes,” Kelly Brownell, dean of the Sanford School of Public Policy at Duke University, told the Times. “Anything slowing it down is good.”

image from The New York Times

Three large sources of data about diet have convinced many health officials that the changes in calorie consumption are meaningful, reports the Times. The first two sources, detailed daily food diaries tracked by government researchers and data from food bar codes and estimates of food production, show a reduction in calories consumed by the average American since the early 2000s. The third source shows a leveling off of the national obesity rate.

While the trend toward eating fewer calories had already begun to surface, a Centers for Disease Control and Prevention report in 1999, which showed the worsening obesity rates in the 1980s and 1990s across the nation, is thought to be the first breakthrough in understanding the magnitude of America's obesity problem. Soon after this study was released, the surgeon general issued a report that summarized the effects of obesity as a risk factor for several chronic diseases.

Now the Patient Protection and Affordable Care Act requires chain restaurants to publish the calorie content of their meals, and in 2012 the federal government introduced new healthier standards for school meals for the first since 1995. Several cities have also increased their efforts to combat the obesity epidemic by subsidizing produce for the poor, limiting unhealthy foods in day care centers, and placing taxes on sugar-sweetened beverages, reports the Times.

The most common theme of anti-obesity public health campaigns has been a focus on decreasing the consumption of sugar sweetened beverages, reports the Times. And it seems to have worked.

"Americans, on average,purchased about 40 gallons of full-calorie soda a year in 1998, according to sales data from the industry trade publication Beverage Digest analyzed by the Center for Science in the Public Interest. That fell to 30 gallons in 2014, about the level that Americans bought in 1980, before the obesity rates took off," Sanger-Katz reports.

But public officials in the article also note that while overall Americans are eating less of everything, they aren't eating a healthier diet; the consumption of fruits and vegetables remains low, and the consumption of desserts remains high.

Chart from "The State of Obesity" report, 2014

Notably, more than a third of American adults are still considered obese, which also holds true in Kentucky, which ranks fifth in obesity among the states and has moved up in rank over the years, according to the 2014 "State of Obesity" report.

“The food part of our diet is horrendous,” Barry Popkin, a University of North Carolina professor who has studied food data extensively, told the Times.

There are demographic differences, and nagging problems. White families have reduced their calories more than black and Hispanic families; families with children have cut back the most; and Americans who are considered the heaviest have cut back the least, with their weight and waist circumference continuing to increase.

A paper by Kevin Hall, a researcher at the National Institutes of Health, says that the recent reductions in calories are not enough to stem the current obesity epidemic, estimating that for Americans to return to the body weights of 1978 by 2020, an average adult would need to reduce calorie consumption by 220 calories a day.

Tuesday, July 28, 2015

LOUISVILLE -- Republican Matt Bevin said Tuesday that if elected governor
he would not immediately end the state’s expansion of eligibility for the
federal-state Medicaid program, contrary to what he said for months.

“That’s not what I’m calling for, at all,” he said at a forum
with Democratic Attorney General Jack Conway at the Kentucky Chamber of
Commerce’s Business Summit and Annual Meeting in Louisville.

Instead, Bevin said afterward, he favors a modified plan
based on the experience of other states such as Indiana, which received federal
waivers to create a complex program in which Medicaid beneficiaries pay
premiums (as small as $1 a month) to get better benefits, and some clients make co-payments for non-emergency
use of emergency rooms.

Republican legislators seem headed in the same direction. On
Monday, the legislature's top Republican said he favored a
modification, not a cancellation, of the expansion that provides free health
care to more than 400,000 people – and that he liked the Indiana example.

Senate President Robert Stivers of Manchester said, “The discussion that
I have heard would be transitioning to a different model of covering that population,
and I know from talking to several people that they’re looking at other models.
I think other states have done that and gotten waivers, particularly Indiana.”

Stivers added, “When you look at this, and I think most
people will talk about when they’re discussing it, it’s more a scalpel approach
than a sledgehammer.” Republican Appalachian districts like Stivers' have seen some of the largest declines in percentage of the population without health coverage.

Bevin began saying in February that he would end the
expansion immediately, which would require an executive order. Stivers made
clear that he thinks decisions about Medicaid should be made by the
legislature.

Stivers said it was not appropriate for the 1966 legislature
to authorize governors to get all the Medicaid money they could – a law Beshear
used to expand the program without legislative approval – and that it would not
be appropriate for future governors to leave legislators out of the equation.

(Video from The Courier-Journal)

Bevin said that if elected, he wouldn’t “have the ability to
just shut things down. It’s like going to war. You don’t just come home on
Tuesday.”

Told that he could issue an executive order ending it the
next month, he replied, “And create what degree of chaos?”

Reminded that he had said he would end it immediately, he
said “I said I would address it. I didn’t say I would end it immediately. Go
back and look at what I said.”

The Lexington Herald-Leader and The Associated Press
reported in February that Bevin said he would end the expansion “immediately.” Herald-Leader reporter Sam Youngman reminded Bevin of that.

Bevin said, “Yeah, well, here’s the bottom line:
We need to address the situation. We need to effectively come up with a program
that works for folks.”

Conway has used Bevin's "immediately" line to claim that Bevin would "on day one" remove all the expansion enrollees from the Medicaid program, and did so twice during Tuesday's forum.

Earlier in the post-forum press conference, Bevin was asked what he likes
about Indiana’s Medicaid expansion.

“What I like about it is the sense of ownership” that it
gives clients, he said. “It’s giving people a vested interest, because when
people do not have any control over their own lives, including the decisions
they make as it relates to health care, even if it’s a token amount, even if it’s
five or 15 or 25 dollars a month – which seems token to some but isn’t token to
some of these folks. Having skin in the game is a big, big differentiator when
it comes to whether or not a person has the dignity that comes with making
decisions for themselves. . . . They’re treating people with dignity and
respect, and giving them the belief that they have control over their own
situation and people are seizing that.”

According to the Kaiser Family Foundation, Indiana offers
four separate Medicaid packages, and further differentiates among clients according
to income, frailty and premium payments. Non-frail adults above the federal
poverty level are taken off the program after they fail to pay premiums for six
months. Also, coverage starts with the first premium payment, not the
application for coverage.

In almost all other Medicaid expansion states, including
Kentucky, free care is given to people with household incomes up to 138 percent
of the federal poverty level. The old threshold in Kentucky was 69 percent.

Indiana limits premium payments to 2 percent of income ($27
per month for those at 138 percent of the poverty level). Premiums go into a
health savings account and offers incentives for clients to follow healthy
behaviors: If their health-savings account has money left over at the end of
the year, they can roll it over; if they receive preventive services, the rollover
balance is doubled, up to the total premium payment for the year.

The federal government pays the entire cost of the expansion through next year. In 2017, the state begins paying 5 percent, rising to the federal health-reform law's cap of 10 percent in 2020. Bevin said he would change the program before 2017.

Conway, asked during the forum how he would pay the state's share, cited a Deloitte Consulting study for the state that showed the expansion would add a net $77 million to the state budget in 2017 and $87 million in 2018, through expanded jobs in health care and taxes paid by those workers.

The study also says the expansion will pay for itself in 2019 and 2020, but not in 2021. If the study's predictions fall short, Conway said, the state could seek waivers to reduce its costs.

Bevin again dismissed the study, calling it "nonsense." He said Kentucky should "be more creative than just grabbing free money form the federal government," apply for waivers and "look at what other states are doing. Don't reinvent the wheel. Let's look for ways to do what Indiana, to the north, is pioneering."

The 2012 legislation to crack down on abuse of painkillers in Kentucky had an immediate and significant effect, according to a study by researchers at the University of Kentucky.

"Doctor shopping," defined as a patient receiving multiple prescriptions from at least four prescribers and at least four pharmacies in a three-month period, declined by 52 percent, according to the researchers' analysis of 2009-2013 data from the Kentucky All Schedule Prescription Electronic Reporting system, which tracks prescriptions for controlled substances.

Interviews with prescribers, pharmacists and law-enforcement officials found that they "believed KASPER to be more effective at reducing doctor shopping than reducing the abuse and diversion of prescription drugs," study report says. "This perception may be a direct result of the impact of mandatory registration and greater use of KASPER by these professionals."

Use of the KASPER system increased greatly, with 322 percent more pharmacists and 262 percent more prescribers using it, and making 650 percent more queries to see patients' prescription history, said UK's Institute for Pharmaceutical Outcomes and Policy.

The number of prescribers of controlled substances (CS) declined 14 percent. "A minority of prescribers indicated they no longer prescribe CS, or prescribe fewer CS, as a result of the HB1 mandate and its burden on their practices," the report says. However, "multiple analyses in this

comprehensive evaluation argue against a blanket chilling effect" of the legislation, 2012 House Bill 1.

At the other end of the spectrum, some doctors still seem to be prescribing too many drugs. "High-volume prescribers contribute significantly to the overall prescribing of CS in Kentucky and the Cabinet for Health and Family Services should continue to identify and investigate top prescribers for appropriate prescribing practices," the researchers wrote.

At a press conference held to announce the study, Gov. Steve Beshear said the Kentucky Board of Medical Licensure, which filed no CS actions against health-care providers in 2011, has since filed 196 actions against 192 providers.

"What has happened is a cultural shift among the Board of Medical Licensure," which is now working with law enforcement, said Attorney General Jack Conway, who battled with the board and the Kentucky Medical Association, the physicians' lobby, during debate over the legislation.

Conway is the Democratic nominee to succeed Beshear, also a Democrat. Senate President Robert Stivers, a Republican, credited Beshear with encouraging the board to be more active.

The legislation also targeted "pill mills" where painkillers were easy to get. Conway said, "We've shuttered just about every one of the state's non-compliant clinics."

Officials have said the legislation led to a rise in heroin use and overdoses, but the study says the causes are more complicated: "Alterations in the heroin market were underway prior to HB1 and this policy change should not be characterized as the sole contributor to the rise in heroin abuse in Kentucky."

Sunday, July 26, 2015

Fewer teens are having sex now than did in the last generation, and of those that do, more are using some form of birth-control, according to a new report from the Centers for Disease Control and Prevention. The Kentucky Youth Risk Behavioral Survey, which offers data from 1997, shows similar trends in Kentucky.

Click on image to view larger version

The percentage of Kentucky girls who reported they have ever had sex dropped 14 percent, to 43 percent in 2013 from 50.3 percent in 1997, and the boys dropped 23 percent, to 46 percent in 2013 from 60 percent in 1997, according to the YRBS.

Nationwide, the CDC report found the percentage of teen girls who reported they've had sex at least once also dropped 14 percent, to 44 percent in 2011-13 from 51 percent in 1988. Among boys there was a 22 percent decrease, to 47 percent in 2011-13 from 60 percent in 1988. The rate of sexual activity among teens from 2002 to 2013 averaged 45 percent.

In 2013, fewer Kentucky high school students than ever, 44.7 percent, reported that they had ever had sex, compared to 53.7 percent in 1997, the highest percentage reported over the years surveyed.

Data from the national report was compiled from the 1988 and 2011-13 National Survey of Family Growth of boys and girls aged 15 to 19.

One reason for the trend toward less teen sex might be that teens have more access to information via the Internet and are more comfortable searching for credible information about sexual health, Dr. Brooke Bokor, an adolescent medicine specialist at the Children's National Health Systemtold Danielle Paquette and Weiyi (Dawn) Cai of The Washington Post.

Dr. Boker also suggested that the growing popularity of the human papillomavirus vaccine has forced a conversation about sexual health between young patients, parents and their physician.

"They learn from doctors that you can catch HPV even if you use a condom," Bokor told the Post, emphasizing some common conditions spread through skin-to-skin contact. "They might think: How else can I stay healthy?"Teens using more birth control

Click on image to view larger version

More teens are now using birth control and most often it's a condom, according to the CDC report.

At 97 percent usage, the condom is the most common "ever used" contraceptive among teens, followed by withdrawal at an alarming 60 percent and the pill at 54 percent. Very few teens use the patch, an intrauterine device (IUD) or a hormonal implant, even though these methods have a higher rate of effectiveness. Notably, the use of emergency contraception -- like the Plan B pill -- for teen girls grew from 8 percent in 2002 to 22 percent in 2013.

The report also found that teens who reported using some form of birth control during their first sexual encounter were half as likely to become teen moms than those who did not.

Teen birth control in Kentucky

The Kentucky YRBS approached this question by asking teens who had reported being currently sexually active if they had not used certain birth control options during their last sexual intercourse encounter. In 2013, 31.7 percent of Kentucky's high school students said they were currently sexually active.

Of this group, 46.9 percent said they did not use a condom; 80.1 percent said they did not use the birth control pill; 97.4 percent said they did not use an IUD; and 95.1 percent said they did not used a shot, patch, or birth control ring.

Click on image to view larger version

It also asked this group if they didn't use any method of birth control the last time they had had sex and found that 15.1 percent said they had not: 18.6 percent of females and 11.2 percent of males.

How effective is your birth control?

Eighteen percent of women who use condoms, 22 percent of women who use withdrawal and 24 percent of women who use fertility awareness get pregnant during the first year if they use these methods, according to the CDC. The pregnancy rate is much lower for other methods.

IUDs (.05 percent) or an implant (0.2 to 0.8 percent) offer the best protection against an unwanted pregnancy, followed by the pill (9 percent), injectable (6 percent), patch (9 percent), ring (9 percent) and diaphragm (12 percent), according to the CDC.

When are teens likely to have sex?

Click on image to view larger version

The CDC report found that it is more likely for teen boys to start sex at an earlier age than girls, but by age 17, the probabilities of having had sex were about the same. This was also found to be true in the Kentucky YRBS.

For males, 18 percent reported having sex at age 15 compared to 13 percent of females and at age 17, 44 percent of males reported having had sex,compared to 43 percent of females. And this trend continued through age 19.

The Kentucky YRBS asks who has had sex for the first time before age 13 and found that 5.4 percent of teens in Kentucky had had sex before age 13 -- 3.2 percent of the girls and 7.5 percent of the boys.

To see if the national trends related to age and sex held true in Kentucky, we looked at the Kentucky YRBS question that asks who has ever had sex broken down by grade levels among the 44.7 percent of high-school students that had ever had sex (43.3 percent girls and 45.9 percent boys): 24.6 percent were in 9th grade (21 percent girls and 28 percent boys); 35 percent were in the 10th grade (32.2 percent girls and 38 percent boys); 59.3 percent were in 11th grade (57.7 percent girls and 60.7 percent boys); and 64.5 percent were in the 12th grade (66.5 percent girls and 62.3 percent boys).

Why does it matter?

Fewer teens having sex coincides with the nationwide trend of fewer teen births. In 2013, the nation's teen birth rate was at its lowest ever: 26.6 births per 1000 females ages 15 to 19. Kentucky's teen birth rate, while higher than the national average, was also at its lowest ever at 38.7 teen births per 1000 females ages 15 to 19.

In 2010, the CDC reported that teen pregnancy and birth cost the nation an estimated $9.4 billion a year.

The Kentucky Department of Public Health "Teen Pregnancy Prevention in Kentucky" report says that in 2008, teen childbearing in Kentucky cost taxpayers at least $158 million. It also lays out the high social cost to both the teen parent and their families, such as the mother is less likely to graduate from high school; there is a nine times increase in the chance that the mother and child will live in poverty; teen mothers often receive little or no prenatal care; and there is an increased chance of infant mortality.

Saturday, July 25, 2015

As the U.S. health secretary reminded the national governors' conference that the administration is trying to put another $100 million into fighting drug addiction, Gov. Steve Beshear cited Kentucky as an example for other states to follow on drugs and health reform.

After mentioning the 2012 legislation aimed at abuse of prescription painkillers, Beshear said, "This addiction situation is akin to the game of whack-a-mole. . . . You attack one and another pops up someplace else. . . . Now heroin has raised its ugly head and is killing even more people than prescription drug abuse is."

Beshear cited the anti-heroin legislation passed this year, with expanded drug treatment and locally authorized needle exchanges, he said, "I think we've all figured out that we cannot incarcerate ourselves out of this problem."

Beshear told the governors, meeting in White Sulphur Springs, W.Va., that he expects to "hear positive news" this month about efforts against prescription drug abuse in Kentucky.

The Obama administration has asked Congress for an extra $100 million to fight drug addiction. Health and Human Services Secretary Sylvia Burwell told the governors that about a third of the funds would go toward "addiction-fighting medications, which have been the
cornerstone of the government’s approach to fighting opioid use," Sarah Ferris reports for The Hill. The money would "go to community health centers in 11 states that are on the frontlines of the fight against opioid addictions."

Burwell also advocated expanding eligibility for the federal-state Medicaid program under Obamacare, which 30 states including Kentucky have done but 20 led by Republican governors or legislatures have not.

Beshear said Kentucky's expansion has cut uncompensated care in Kentucky's rural hospitals to 5 percent, from 25 percent, and said many are in the black "for first the time in a long time." Many rural hospitals have said other features of the health-reform law have hurt them, but Beshear said, "From a revenue standpoint
having expanded Medicaid has been a boon to our providers.

He also said it has been good for the economy, citing the study by Deloitte Consulting that says the expansion has "already created 12,000 jobs
in health care" and will infuse $40 billion into the state's economy through 2021. The job figure appears to be total jobs, not in health care, which accounts for 40 to 45 percent of the total jobs generated, under the model used by Deloitte.

If the next governor continues the expansion, the state will have to start paying a small part of it in 2017. Beshear did not make the usual argument, supported by the study, that the expansion will pay for itself through 2020 by bringing formerly uninsured people into the health-care system and generating jobs and tax revenue.

He did address other arguments, that the federal government "will back away" from the expansion or that the cost will be too great. "You can stop," he said. "I
know a lot of legislatures have a problem just because of the name of the act,
but if you can get past that kind of politics ... It's gonna cut down on the
big costs down the road," through cancer screenings and so on.

Virginia Gov. Terry McAuliffe, who has failed to persuade his Republican-controlled legislature to expand Medicaid, asked his fellow Democrat, "Steve, you want to come up to Virginia for a
couple of days? I could use that."

The second annual "Hepatitis Conference: The Silent Epidemic in Kentucky" will be held Tuesday, July 28, the same day as World Hepatitis Day, at the Embassy Suites, in Lexington. The conference aims to provide information about prevention, diagnosis and treatment of those affected by hepatitis B and hepatitis C.

Kentucky leads the nation in the rate of acute hepatitis C, with 4.1 cases for every 100,000 residents, more than six times the national average, according to the federal Centers for Disease Control and Prevention.

Hepatitis B is a highly infectious virus that attacks the liver and can lead to severe illness, liver damage and death. It is spread through blood and certain body fluids. There is no cure for hepatitis B, but there is a three-dose vaccination for it. Hepatitis C is also a virus that attacks the liver, and is spread through blood contact. It does not have a vaccination.

The conference will host Dr. John Ward, director of CDC's viral hepatitis program, as its keynote speaker. State Health Commissioner Stephanie Mayfield will offer opening remarks.

A full day of presentations will include an array of topics including hepatitis in infants, hepatitis in children, co-infections of hepatitis and HIV, prevention, treatment. incorporating hepatitis into telehealth, and several sessions regarding hepatitis among people who inject drugs and drug addiction

The event is presented by the Kentucky Department for Public Health and its Adult Viral Hepatitis Prevention Program, and the Kentucky Rural Health Association.

Friday, July 24, 2015

A new online database is available to help consumers choose a surgeon, but surgeons are pushing back and asking for a peer-reviewed study of the data.

The searchable database, "Surgeon Scorecard," was created by ProPublica, a nonprofit journalism organization, by using five years of Medicare records to calculate the death and complication rates for nearly 17,000 surgeons performing one of eight elective procedures including knee replacements, the data include knee replacements, hip replacements, cervical spinal fusion, two types of lumbar spinal fusions, gall bladder removal, prostate resection and prostate removal. The website says the scorecard was "guided by experts" and the data were adjusted for differences in patient health, age and hospital quality.

This analysis comes at a time when federal health officials are focusing more attention on these common surgeries, Laura Ungar reports for The Courier-Journal.

"This month, the U.S. Centers for Medicare and Medicaid Services announced a proposal to cut Medicare payments to hospitals with high rates of complications for hip or knee replacements," Ungar reports. "About a quarter of the 400,000 hip and knee replacements Medicare patients undergo each year will be affected by the proposed rule."

Leah Binder, president and CEO of the Washington-based Leapfrog Group, a nonprofit organization that rates hospitals, told Ungar that she commended ProPublica for analyzing the data in a way that's useful for consumers. "Complication rates are a strong sign of a certain skill level," she said. "This information is housed by our government, and as taxpayers, we deserve to know how surgeons are doing."

Charles Mick, a spine surgeon in Massachusetts who advised on the project, told Nick Penzenstadler of USA Today that the project is "long overdue. Consider baseball, if you're a batter but never knew if you hit the pitch, how could know you know if you're getting better?" Mick argued that the "uncomfortable public exposure is a small price to pay for better patient care."

But surgeons have taken to the Internet with complaints about the report with editorial headlines like: "ProPublica's Surgeon Score Card: Clickbait? Or Serious Data?" written by Dr. Benjamin Davies for Forbes; "Why the Surgeon Scorecard is a journalistic low point for ProPublica" by Dr. Jeffry Parks on his medical blog; and an open letter titled "ProPublica's Surgeon Scorecard: Call for Peer Review" by Dr. Edward J. Schloss, to name a few.

These physicians argue that there are problems with the methodology, such as overly wide statistical confidence intervals for complication rates, questions about using readmission rates as a measure of complications, considering readmission as equal to death, and not using enough criteria to make these claims.

"ProPublica rightly has high expectations for surgeons and has courageously started a worthwhile process," Davies writes for Forbes. "What they have not done is given pause — or honest reflection — on the obvious harsh limitations of the data they have processed. Instead, we got a clickbait video and a parboiled dataset."

Another study has found that overweight teens in the U.S. don't realize they are overweight, and this lack of self-awareness has gotten worse in the past decade, Roberto A. Ferdman reports for The Washington Post

The study, at Georgia State University, tracked data from the National Health and Nutrition Examination Survey for nearly 2,000 teenagers between the ages of 12 and 16 in the early 1990s and over 2,500 teenagers in the same age range between 2007 and 2012. The survey included the body-mass index of each child in the study and also their answer to the question: "Do you consider yourself to be overweight, underweight, or just about the right weight?"

The research found that fewer adolescents think they are overweight today, even though more of them are overweight, Ferdman reports.

"Within a short time scale, the likelihood that overweight or obese teens believe that they are overweight declined by almost 30 percent," Dr. Jian Zhang, a researcher from the university, told Ferdman.

And this misperception was more pronounced among the younger children as overweight 12-year-olds in the study were almost 40 percent less likely to recognize that they were overweight today, compared to 20 years ago, Ferdman reports.

A report last year by the federal Centers for Disease Control and Protection found that almost half of America's obese youth don't know they're obese.

"The trend is very dangerous," Dr. Jian Zhang told Ferdman.

Adding to this conundrum, a different study published last year by Zhang found that parents are "significantly less likely to realize that their child is obese than they were 20 years ago." This was also the result of a study out of NYU Langone Medical Center that found most parents of overweight children consider them to be "about the right weight."

"The society as a whole is stuck with a vicious cycle," Zhang told Healthday last year. "Parents incorrectly believe their kids are healthy, they are less likely to take action, and so it increases the likelihood that their kids will become even less healthy."

Zhang attributes these misperceptions to the fact that people judge their weight based on the people around them, and the people around them are getting fatter.

This is especially true in Kentucky, which ranks first in the nation for high-school obesity, at 18 percent and eighth for obesity in 10 to 17-year-olds, at almost 20 percent, according to the "States of Obesity" report.

Zhang also notes that overweight and obese teens may be reluctant to admit that they are overweight because of the harsh messages relayed by the weight-loss industry.

Ferdman writes that the solution is not as easy as just informing teens that they are overweight, especially because teens often have fragile body images.

"We must be very careful when we, as parents, teachers, or health care professionals, make an effort to correct the misperception among teens," Zhang told Ferdman. "It has to be a pro-health, not anti-obesity, campaign."

Thursday, July 23, 2015

LOUISVILLE, Ky. -- Republican gubernatorial nominee Matt Bevin wouldn't say Thursday what he would do with the 430,000 Kentuckians who would lose their new Medicaid coverage if he is elected governor and cancels the expansion of eligibility for the program.

At a Kentucky Farm Bureau forum in Louisville, Bevin and Democratic Attorney General Jack Conway were asked how they would pay for the expansion of the federal-state program once the state starts paying 5 percent of the bill in 2017, rising to the federal health-reform law’s cap of 10 percent in 2020.

Conway cited a study for the Beshear administration predicting that the expansion would pay for itself through 2020, by creating health-care jobs and tax revenue. It says there would be a net loss in 2021, the last year of the study.

Conway said there are too many people on Medicaid, but said the solution for that is a better economy. “What I am not going to do is what my opponent will do on day one, which is by executive order kick half a million people off health insurance based on whether we can or can’t afford it in 2021. To me, that’s not courageous, that’s callous. . . . If we can’t afford something, we can potentially scale back.”

Bevin said the “day one” line was “an absolute lie,” but when he was asked in February about the expansion, he said “No question about it, I would reverse that immediately.”

As he has done before, Bevin conflated the Medicaid expansion with Kynect, the state health-insurance exchange where Kentuckians can get subsidized health insurance or, if their household income isn’t more than 138 percent of the federal poverty line, sign up for free Medicaid.

“With respect to the Kynect program, we cannot afford to have 25 percent and fast growing toward 30 percent on Medicaid, period, whether you like it or not, whether you think it’s fair or not, whether there’s supposedly a need or not, truth be told, we can’t afford it.”

He said later, “We’re gonna dismantle the Kynect program. We’re not gonna have 25 percent of Kentuckians on Medicaid."

At a post-forum press conference, Bevin acknowledged that Kynect and Medicaid are separate programs. But he continued his attack on the study, which during the forum he had called “nonsense” and “absolute rubbish.” He said during the forum that if putting 25 percent of Kentucky on Medicaid would create so much economic activity, “Why not put all of us on Medicaid?”

Health reform was designed to help people who couldn’t afford or were denied coverage, and as a result the uninsured population in Kentucky has dropped to less than 10 percent, from above 20 percent. Medicaid enrollment has leveled off and may be declining as the economy improves.

Bevin said the study failed to account for jobs that have been lost because of health reform. In fact, the study was about the effects of Medicaid expansion, which the state controls, not health reform in general, which is a federal issue. And it was done by an internationally respected firm, Deloitte Consulting, that rejected state Health Secretary Audrey Haynes' request to include the expected benefits of a healthier population, which would have been somewhat speculative.

It remains to be seen whether the study’s predictions will pan out. Job creation in health care fell short of the study’s projections last year, but recent monthly figures have shown significant gains, and Haynes says the expansion is still on track to pay for itself through 2020. University of Louisville economist Paul Coomes says annual figures are more reliable.

After the formal press conference, Bevin got more questions about Medicaid, and repeated an argument he has made before, that health coverage doesn’t equal health-care access – that there aren’t enough health-care providers, as shown by the increased use of many emergency rooms.

As the questioning continued, Bevin said he had explained what would happen to the 430,000 new Medicaid beneficiaries. Told that he hadn’t, he replied, “They’re Kentuckians. They will continue to live in Kentucky if they choose to.”

Oldham County school officials report that a waxy form of marijuana in e-cigarettes, as well as heroin, are becoming more prevalent among students, Taylor Riley reports for The Oldham Era.

"At least eight students were taken to the hospital or medical offices, just after spring break, due to the effects of using vape oils with electronic cigarettes, according to Dan Orman, assistant superintendent," Riley reports.

Orman referred to a new marijuana product on the market called Wax, which has a waxy texture and yellow color. It is made from the oils of marijuana plants and has a high level of THC, the ingredient in marijuana that makes a user high. This product melts as it heats up in an e-cigarette and can be smoked. It is much stronger than marijuana and is undetected by sight or smell.

"It’s very dangerous to the developing brain," Orman said. He presented the report at the board of education meeting and said there had been a "huge decrease" in prescription pill use in the Oldham County schools, but heroin use is on the rise, which "seems to be the trend everywhere in Kentucky," Riley reports.

Earlier this year, Carrollton police officer Tim Gividen toldWLKY-TV that this product had been an issue in high schools in Carroll and Trimble counties, just north of Oldham and toward Cincinnati.

"In a 2011 survey by the Centers for Disease Control and Prevention, 5.2 percent of Kentucky’s high-schoolers reported using heroin, nearly double the national average. By the time the teens hit their senior year, use had grown to 7.7 percent, nearly 5 points higher than the nation’s average," Terry DeMio reports for The Cincinnati Enquirer.

The director of Operation Parent, Jean Schumm, told Riley that parental engagement was the key to helping kids from "going down the wrong road." She also suggested that drug and alcohol prevention needs to start earlier, in the fourth and fifth grade, instead of high school, because this is when kids start to experiment. Operation Parent is a LaGrange-based nonprofit for parents of pre-teens.

Orman agreed: "Parents should be aware of all possible substances their children may be ingesting or abusing. There are many over-the-counter and illegally obtained drugs that young people may abuse for recreational purposes. Awareness and constant vigilance are the best tools parents can use to help keep their kids safe."

The Clinton County Board of Education has voted to make all of the county's school campuses tobacco free, but decided to not implement this program until the 2016 school year begins to give the public more time to adjust to the new rule, reports the Clinton County News.

"Board member Junior Cecil indicated he would rather have seen the measure take affect with the start of this school year, but board chairperson Paula Key said after considering the move, which has been discussed for the past few months, it was decided to give the public more time to become aware of the new rule and get adjusted to it," the newspaper reports.

The board also passed a second motion to collaborate with the Lake Cumberland District Health Department for a $14,000 tobacco-free campus grant to be used for a 12-month media campaign and public awareness program to inform the public about the Tobacco Free School program. A similar campaign has been used in Casey County, which will go tobacco-free this school year.

"The tobacco-free school policy will not only ban smoking on school property during in school hours or school sponsored events, (i.e. ball games) but also include the banning of any use of any type of tobacco products," the newspaper reports. The policy will also include electronic cigarettes and all vapor products.

As of June 2015, 44 school districts, out of 173 in Kentucky, were entirely tobacco-free, according to the state's "100% Tobacco Free Schools" website.

Wednesday, July 22, 2015

For the second consecutive year, Baptist Health Lexington is recognized as Kentucky's best hospital by U.S. News & World Report. It was also recognized as a nationally ranked hospital for adult ear, nose and throat care.

St. Elizabeth Edgewood in Northern Kentucky was ranked second in the state. It was ranked No. 5 in the Cincinnati metro area and high-performing in three adult specialties: diabetes and endocrinology, geriatrics, pulmonology and four adult procedures and conditions: chronic obstructive pulmonary disease (COPD), heart bypass surgery, hip replacement and knee replacement.

Norton Hospital in Louisville and Baptist Health Louisville tied for third in the state, followed by the University of Kentucky'sChandler Hospital. Kosair Children's Hospital in Louisville was ranked as the best children's hospital in Kentucky.

U.S. News' Best Hospitals rankings, now in their 26th year, ranks hospitals both nationally and regionally on how well they treat the most challenging patients. Nearly 5,000 hospitals were analyzed for this year’s rankings. Kentucky has 129 hospitals.

In addition to being ranked first in Kentucky, Baptist Health Lexington ranked 39th nationally for ear, nose and throat care for adults and was rated high-performing for four adult procedures and conditions: COPD, heart bypass surgery, heart failure and knee replacement. High performing hospitals are in the top 10 percent of centers analyzed for the rankings.

“These national rankings underscore what our patients have experienced for years – the very best of care,” Baptist Health CEO Steve Hanson said in a press release. “Our physicians and staff are constantly working on quality and safety initiatives, not just to keep our scores high, but because it’s the right thing to do for the people we serve. It is gratifying to see that commitment recognized.”

Norton Hospital was rated high-performing in five adult specialties: gastroenterology and GI surgery, nephrology, neurology and neurosurgery, orthopedics and pulmonology and one adult procedure and conditions: heart bypass surgery.

The UK hospital was rated high-performing in five adult specialties: cancer, geriatrics, neurology and neurosurgery, orthopaedics, and pulmonology. It did not have any high-performance ranking in adult procedures and conditions, and ranked below average in this category for heart failure.

The report points out that these rankings are just one tool of many to use when deciding which hospital to consider, "Individual diagnosis and personal priorities will dictate the best choice," for patients and their physicians, it says.

Tuesday, July 21, 2015

ANNVILLE, Ky. – Two to five new graduates of Kentucky's dental schools will each have up to $150,000 of their tuition debt forgiven if they practice dentistry in Appalachian Kentucky, under a pilot program state and university officials announced July 21.

Gov. Steve Beshear said the money will come from existing funds in the state Department of Public Health and will go to the dental schools at the University of Kentucky and the University of Louisville.

The shortage of dentists in Appalachian Kentucky is often cited as one reason the region and the state have such poor oral health.

"The lack of oral health care is a very serious problem in the commonwealth," Beshear said, noting its appearance in news and reality shows: "Too often the face of our state is represented by a person with a number of missing teeth." He said that's an incorrect stereotype, but noted that only three states have a higher percentage of residents missing six or more teeth.

The pilot program will run for two years. It will cover up to $100,000 in outstanding dental-school loans for a new dentist who practices two years in Appalachian Kentucky. The commitment can be renewed for one to two more years to get another $50,000 in debt relief.

"We think this is going to be a very attractive program," Beshear said, noting that the average debt of a U.S. dental-school graduate is about $280,000. U of L Dental School Dean John Sauk said starting a dental practice costs about $500,000, so "Going home to serve the communities in which they grew up is often not an economical option" for new dentists.

The program will give priority to students from Eastern Kentucky and graduates who practice in economically distressed areas.

"A lot of our graduates at UK and U of L really want to return home to practice," said Dr. M. Raynor Mullins, project leader of the Appalachian Rural Dental Education Project of the UK Center for Oral Health. "I hear that from them every day, but high student debt is a real barrier."

U.S. Rep. Harold "Hal" Rogers said the program should send some in his Fifth District back home. He said dental-care access has been poor because "We've shipped out our talent for their education and the rest of their productive life" and given them little incentive to return. Meanwhile, more than half of Eastern Kentucky children aged 2-11 have tooth decay, he said.

Beshear said the program will save money in the long run by heading off more expensive dental treatment and costs for other health problems cause by lack of oral health.

Dentists in the program will be required to accept Medicaid patients. One obstacle to oral-health access in Appalachia is that many dentists won't accept Medicaid, citing low reimbursements.

More dentists than ever are needed to treat the hundreds of thousands of Kentuckians newly covered by Medicaid after the state's expansion of the federal-state program. State Health Secretary Audrey Haynes said 270,000 of the nearly 500,000 children enrolled in Medicaid visited a dentist last year.

"For our children, dental care has been particularly problematic," Beshear said. "Hundreds of thousands of children don't see a dentist regularly and many at all" and suffer pain, anxiety and low self-esteem "because dental problems can be pretty visible."

Haynes illustrated the impact of the Medicaid expansion by reporting that fewer than 84,000 adults had a Medicaid dental visit in 2013, the year before the expansion, and that almost 184,000 visited a Medicaid dentist in 2014.

The announcement preceded a meeting of the executive committee of Shaping Our Appalachian Region, the bipartisan initiative started by Rogers and Beshear. Rogers' endorsement of the pilot program suggests he may use it as the basis for federal appropriations or legislation to help other rural areas that need dentists or even doctors.

"When you put people first and politics second," said UK President Eli Capilouto, "a lot can happen." Capilouto, a dentist by trade, said the program "will make a big difference."

Mullins said, "We now have a lot more assets in the Appalachian region that we've never had to work with," including a dental education partnership with Morehead State University.

In 2013, 10.6 percent of Kentucky adults had diabetes, a big increase from 2000, when 6.5 percent had the disease, according to the 2015 Kentucky Diabetes Report. In a few years, diabetics may no longer need to inject insulin, and researchers have invented an insulin patch that can measure increases in blood sugar levels and release insulin into the bloodstream when it's required.

The penny-sized patch includes more than 100 small needles about the size of an eyelash. Each needle has insulin storage units and glucose-sensing enzymes. More clinical trials in humans will be required before the patch can be given to patients, but the study, published in the Proceedings of the National Academy of Sciences, discovered that the patch could lower blood glucose in a mouse model of type 1 diabetes for up to nine hours.

"We have designed a patch for diabetes that works fast, is easy to use and is made from nontoxic, biocompatible materials," said co-author Zhen Gu, a professor in the joint University of North Carolina and North Carolina State University Department of Biomedical Engineering. "The whole system can be personalized to account for a diabetic's weight and sensitivity to insulin, so we could make the patch even smarter."

"Injecting the wrong amount of medication can lead to significant complications like blindness and limb amputations or even more disastrous consequences such as diabetic comas and death," said John Buse, co-senior author of the paper and the director of the UNC Diabetes Care Center. The patch imitates the body's beta cells, which are natural insulin generators.

"The hard part of diabetes is not the insulin shots, or the blood-sugar checks, or the diet, but the fact that you have to do them all several times a day every day for the rest of your life," Buse said. "If we can get these patches to work in people, it will be a game changer."

Kentucky ranks 34th in the nation for overall child well-being, showing the most improvement in health and a significant decrease in teen births in recent years, according to the Kids Count report, released by the Annie E. Casey Foundation and Kentucky Youth Advocates.

The annual report offers a state-by-state assessment that measures 16 indicators to determine the overall well-being of children. The latest data is for 2013, and is compared with data from five or so years earlier.

The report focuses on four major domains: economic security, education, health, and family and community strength. (Click on image for larger version)

Kentucky ranked the highest in health, climbing to 24th from 31st in 2013 and 28th in 2014. Its economic security (32nd), education (30th) and family and community strength (38th) rankings remained similar to the past three years.

“Health may be a political hot potato for many reasons," Dr. Terry Brooks, executive director of Kentucky Youth Advocates, said in a press release. "However, when it comes to kids, the results are clear. Our health ranking stands as a beacon for tangible results for Kentucky kids.”

Kentucky's improved health ranking reflects a 24 percent decrease in child and teen mortality rate, as well as improvements in the percentage of low-birthweight babies (8.7 percent), teens using alcohol or drugs (5 percent), and children without health insurance (6 percent).

"With recent increases in health insurance access through Kynect and Medicaid expansion, we expect to see even more children with coverage and able to receive health care," Susan Zepeda, president and CEO of Foundation for a Healthy Kentucky, said in the release.

A significant area of improvement was found in the family and community domains, where Kentucky showed a 26 percent decrease in teen births between 2008 and 2013.

Though still one of the highest in the nation, Kentucky's teen birth rate decreased to 39 births per 1,000 teen girls ages 15 to 19 in 2013, compared to 53 births per 1,000 teens in 2008. The national average is 26 births per 1000 teens, which is at a historic low level.

"Teenage childbearing can have long-term
negative effects for both the mother and
newborn," says the report. "Teens are at higher risk of bearing
low-birthweight and pre-term babies. And,
their babies are far more likely to be born
into families with limited educational and
economic resources, which function as
barriers to future success."

However, overall in this domain Kentucky got its lowest ranking, showing little change from previous years: 36 percent of Kentucky's children live in single-parent families; 12 percent of Kentucky's children live in families where the household head lacks a high-school diploma; and 16 percent of Kentucky's children live in a high-poverty area, defined as neighborhoods where more than 30 percent of people live in poverty.

The report also looks at education. It shows that Kentucky had a 31 percent decrease in the number of high school students not graduating on time, from 26 percent to 18 percent, but most of its fourth graders (64 percent) can't read at a national proficiency level, and most of its eighth graders (70 percent) are not proficient in math. Those numbers haven't moved much since 2007, when they were at 67 percent and 73 percent respectively.

"Children who reach fourth grade without being able to read proficiently are more likely to drop out of high school, reducing their earning potential and chances for success," says the report, noting that "Students who take advanced math and science courses are more likely to graduate from high school, attend and complete college and earn higher incomes."

Added to this, the percentage of children not attending preschool has increased to 58 percent from 55 percent. "We have to ensure strong early learning is a reality for every youngster," Tom Shelton, executive director of the Kentucky Association of School Superintendents, said in the release. "That means creating an environment in which children learn in every child care center and in every pre-school across Kentucky."

Kentucky improved to 32nd from 35th last year in the economic well-being domain, but that is little to brag about with one in four of Kentucky's children found to be living in poverty. Measures in this domain also found that 34 percent of Kentucky's children live with parents that don't have secure employment; 27 percent live in households with a high housing cost burden; and 8 percent of Kentucky's teens are not in school and are not working.

"Here’s the bottom line from this year’s report: If we as a commonwealth want to get serious about improving the lives of our children, there is one overriding and persistent challenge: poverty," Brooks said. "You can’t talk education or health without talking family economics. And we can begin to tackle persistent poverty only when economic well-being policy stops being political and starts being about the common good."

Sunday, July 19, 2015

FRANKFORT, Ky. – The basic financial premise of Kentucky's expansion of Medicaid under federal health reform is that the addition of so many people and money to the health-care system will create enough jobs to generate state tax revenue sufficient to cover the state's share of the expansion.

However, the jobs numbers have been falling short of projections that support the premise, raising questions for the governor's race and the state budget, which will need money for the expansion in 2017. State officials point to a recent uptick and say the expansion is still on track to pay for itself through 2020.

The federal government is paying the entire cost of the expansion for the first three years, but the state will have to pay 5 percent in 2017, 6 percent in 2018, 7 percent in 2019 and 10 percent (the limit set by the law) in 2020.

The Urban Studies Institute at the University of Louisville estimated in a February 2015 report for the state by Deloitte Consulting that in 2014, the first year of the expanded Medicaid program, that the expansion had created more than 12,000 jobs, including 5,400 in health care.

But the latest adjusted data from the federal Bureau of Labor Statistics show that from December 2013 to December 2014, Kentucky employment in health care and social assistance rose by only 3,100 – from 230,100 to 233,200. The number of health-care jobs is the main driver of other types of jobs related to the expansion.

Charts by Dr. Paul Coomes, University of Louisville

This year, monthly BLS figures show that the growth in health-care jobs has accelerated, to 234,900 in April and 235,700 in May (a preliminary estimate). Those data and other factors help state Health Secretary Audrey Tayse Haynes argue that the expansion is still on track to pay for itself through 2020, the next-to-last year of Deloitte's projections.

"You can't deny that overall employment is up," Haynes said in an interview. She also cited state figures for June, which said Kentucky jobs in health care and education rose by 3,100 in June, for a total gain of 11,900 this year in those combined sectors, broader than the sector defined by BLS.

The one-month gain for health care and social assistance was 2,700, and the gain for the first half of the year was 9,500, or 4.1 percent, said Manoj Shanker, an economist for the state Office of Employment and Training.

"The job growth has been fueled partly by the introduction of over $2 billion in expanded Medicaid Services beginning in 2014," Shanker said, calling it "manna from heaven."

However, retired U of L economist Paul Coomes isn't convinced there is a solid trend. He argues, "It is dangerous to look just a month to month changes. The annual data tell a more comprehensive story."

Coomes points to BLS data showing that Kentucky averaged 230,300 health-care and social-assistance jobs in 2014, down from an average of 231,000 in 2013. "You can see there has been no job growth the last two years," he said.

Haynes argues otherwise. "It doesn't say any of that at all," because of the latest state jobs numbers, she said. "You cannot drop over $2 billion in any economy, but in particular Kentucky's economy, and not see job growth."

Haynes acknowledged that monthly jobs numbers are subject to revision, but said she is confident because the state has now measured jobs for a year and a half of Medicaid expansion. Through 2020, the expansion is estimated to create 40,000 jobs, less than half in health care. Haynes said the estimates should be refreshed each year, perhaps by different researchers.

BLS figures provided by Coomes show that a loss of jobs at Kentucky hospitals is largely responsible for the shortfall in expected health-care jobs.

Haynes said that is a national phenomenon, as hospitals adjust to other features of the Patient Protection and Affordable Care Act. She said services that were once being done only in hospitals are now being done elsewhere, and hospitals now have their Medicare payments reduced if patients are readmitted within 30 days. Kentucky has one of the nation's highest readmission rates.

"Just because there is a specific industry or institution within the overall sector that has had an overall net loss of jobs does not mean that the overall sector has not improved," Haynes said. She said the state could have also applied a readmission penalty to Medicaid patients, but did not.

Kentucky hospitals have said they have been forced to lay off employees because of problems with the managed-care organizations, mostly insurance-company subsidiaries, that oversee care of Medicaid patients.

Hospitals complain that they lose money on each Medicare or Medicaid patient because the government programs reimburse them at less than cost. Haynes and her staff counter that the hospitals no longer have to write off millions of dollars in bad debts because relatively few people now lack health insurance.

"In addition to getting paid lots more by Medicaid, they've also seen their uncompensated care plummet," said Robin Rhea, an economist in the Cabinet for Health and Family Services, which Haynes runs.

Louisville businessman Matt Bevin, the Republican nominee for governor, has said that he would eliminate the Medicaid expansion because the state can't afford it. Attorney General Jack Conway, the Democratic nominee, said last month that the state will have to
find a way to pay for the expansion, and for Bevin to “say you’re going to kick
a half a million people off of health insurance based on what we may or may not
be able to afford in 2021 is irresponsible.”

Friday, July 17, 2015

Gov. Steve Beshear and 5th District U.S. Rep. Hal Rogers plan to announce an "initiative promoting sustained oral health and well-being in Eastern Kentucky," a media advisory from their offices announced Friday. The oral health of the region is among the worst in the nation.The initiative will be a program to help dental students who agree to practice in Eastern Kentucky to repay their student loans at the University of Kentucky and the University of Louisville. UK President Eli Capilouto, U of L School of Dentistry Dean John Sauk, and Dr. Raynor Mullins, project leader of the Appalachian Rural Dental Education Project of the UK Center for Oral Health., will join Rogers, Beshear and state Health and Family Services Secretary Audrey Tayse Haynes at the announcement.

The announcement is scheduled for 1 p.m. Monday, July 20 at the offices of Jackson Energy Cooperative, 103 Mildred Rd. in McKee. The announcement will be followed by a meeting of the executive committee of Shaping Our Appalachian Region, the Rogers-Beshear initiative to help the economy of Eastern Kentucky.

The Kentucky Oral Health Coalition, a project of Kentucky Youth Advocates, recently released an infographic "Word of Mouth: The Importance of Oral Health in Kentucky" to offer some general awareness about dental health. It displays fun facts about oral health as well as details about the consequences of poor oral hygiene and barriers Kentuckians face related to oral health, such as cost and lack of access. View it here (sorry, this is as large as we can reproduce it), or download the full-size PDF version to share.

Every day 2,000 children die from preventable injuries, making unintentional injuries the leading cause of death for children in the United States. More of these injuries occur during the summer than any other season.

"Kids are outside more, out of school and less supervised," said Greg Ozark, associate professor of pediatrics and internal medicine at Loyola University Chicago Stritch School of Medicine. "This leads to an increased risk of injuries, from drowning to head injuries to skin infections from bug bites and poison ivy.

Serious injuries and death can happen in an instant; most drownings occur when a parent hasn't been watching a child for only five minutes.

Ozark said the best method for injury prevention is adult supervision including not only watching the kids, but setting safety rules and leading by example. "Your children are watching you," Ozark said. "They are more likely to do what they see you doing than to do what they hear you saying."

Water safety:
1. An adult should be supervising children spending time around any source of water including pools and lakes; infants and toddlers should be supervised while they are in the bathtub.
2. Children 5 and older should take swim lessons.
3. Young children should always be in arm's reach of an adult.
4. Home pools have to have a four-foot fence surrounding them including a self-locking gate.
5. People of all ages should wear lifejackets while boating, and children should wear lifejackets even on docks and piers.

Wheeled activities like bike riding:
1. Each child needs to wear a helmet approved by the American National Standards Institute. The helmet should fit snugly, sit over the forehead and cover the back of the head. Helmets should be replaced if they get dented or cracked.
2. Children should wear knee and elbow pads and wrist guards while skateboarding.
3. Tell children to be particularly careful around driveways, and children younger than 10 should not be permitted to ride in the street.
4. Always be aware of wear your children are going and do not let them go too far from home.

Playground:
1. Supervise your children while they play on the playground.
2. Playground surfaces should be filled with wood chips or sand, not grass or cement.
3. Report broken equipment immediately, and don't let your children play on it.
4. Home swing sets can pose a strangulation hazard, so check them carefully before children use them.
5. Playground equipment should not be higher than six feet off the ground.

"Be wary, supervise and think about what are potential consequences that could occur by your child's activity," Ozark said. "Whether they are toddlers or teens, there is no age that doesn't need to be supervised."

Thursday, July 16, 2015

With the U.S. Supreme Court approving Obamacare subsidies on the federal health-insurance exchange as well as state exchanges, some Republican legislators in Kentucky say the state should close its exchange, branded as Kynect. But officials of Democratic Gov. Steve Beshear's administration say that would cost money and do away with a successful project.

"Republicans on the Interim Joint Health and Welfare Committee
suggested Wednesday the state may fare better by shuttering kynect in
favor of the federal website HealthCare.gov," Kevin Wheatley reports for cn|2, a news service of TimeWarner Cable. "But Beth Jurek, executive director of the Cabinet for Health and
Family Services’ budget and policy office, said Kynect is better suited
for Kentucky customers than the federal exchange and insurers would be
charged a higher assessment fee on HealthCare.gov if the state exchange
closes. The debate preceded an 11-11 party-line vote to approve this year’s
version of Gov. Steve Beshear’s executive order establishing kynect. The
tie vote allows the order to remain in effect."

The issue also divides the major-party candidates for governor. The Democratic nominee, Attorney General Jack Conway, says he would keep Kynect, but Republican Matt Bevin says he would move its customers to the federal exchange.

The assessment on insurers
for plans sold on HealthCare.gov is 3.5 percent, while Kynect only assesses 1 percent. "The federal government has already covered costs to launch Kynect,
leading Jurek to predict that the state would be responsible for any
costs associated with closing the exchange and moving to the federal
system, such as creating an interface that allows HealthCare.gov to
determine applicants’ eligibility for Medicaid," Wheatley reports.

"On top of any misgivings about the exchange itself, Beshear’s
decision to circumvent a politically divided General Assembly to enact
kynect through executive order in 2012 still has some fuming," Wheatley writes, quoting Sen. Julie Raque Adams, R-Louisville, chairwoman of the Senate Health and Welfare Committee: “I think on the most basic premise, the fact that we deal with this
as an executive order is very offensive to me, because we have completely
extracted the legislative component from a program that actually
touches the lives of everybody who elects us.”

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Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.Republication of any KHN material with proper credit is hereby authorized, but if the republication is longer than a news brief we ask that it contain the first sentence of this paragraph. Thanks!